Yoo Kyung Don, Yoon Hyung-Jin, Hwang Seung-Sik, Heo Nam Ju, Chin Ho Jun, Yang Seung Hee, Joo Kwon Wook, Kim Yon Su, Lee Hajeong
Department of Internal Medicine, Dongguk University Medical Center, Gyeongju, Korea.
Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.
Nephrology (Carlton). 2017 Oct;22(10):804-810. doi: 10.1111/nep.12857.
Renal hyperfiltration (RHF) is a marker of early kidney injury that was recently shown to be a novel marker of mortality. However, it has no clear definition. In this study, we suggested an age- and sex-adjusted RHF definition and explored the association between RHF and mortality by sex.
We analyzed data from individuals receiving routine health examinations from 1995 to 2009. RHF was defined as an estimated glomerular filtration rate over the 95th percentile matched for age and sex.
A total of 114 966 individuals were included. During the 75-month of observation period, 2559 (2.2%) participants died. Among those, 71.4% were men. Because sex and RHF had a significant interaction for mortality (P for interaction < 0.001), we performed survival analysis according to sex. RHF was related to lower body weight and a higher proportion of cigarette smoking in men, whereas these relationships were not found in women. In the Kaplan-Meier curve, RHF was associated with higher mortality rate than non-RHF in both sexes, but this relationship was more prominent in men. In the multivariate analysis, RHF remained as an independent risk factor for all-cause mortality even after adjustment for confounding in men (hazard ratio, 1.34; 95% confidence interval, 1.12-1.59; P = 0.001). In women, RHF was not associated with increased mortality.
We demonstrated that RHF was a significant risk factor for mortality in men but not in women. The mechanisms and clinical implications of these different associations according to sex require a further clarification.
肾高滤过（RHF）是早期肾损伤的一个标志物，最近被证明是一种新的死亡率标志物。然而，它没有明确的定义。在本研究中，我们提出了一种经年龄和性别调整的RHF定义，并按性别探讨了RHF与死亡率之间的关联。
我们分析了1995年至2009年接受常规健康检查的个体的数据。RHF被定义为年龄和性别匹配后估计肾小球滤过率超过第95百分位数。
共纳入114966名个体。在75个月的观察期内，2559名（2.2%）参与者死亡。其中，71.4%为男性。由于性别和RHF对死亡率有显著的交互作用（交互作用P<0.001），我们按性别进行了生存分析。RHF与男性较低的体重和较高的吸烟比例有关，而在女性中未发现这些关系。在Kaplan-Meier曲线中，RHF在两性中均与高于非RHF的死亡率相关，但这种关系在男性中更为突出。在多变量分析中，即使在对男性的混杂因素进行调整后，RHF仍是全因死亡率的独立危险因素（风险比，1.34；95%置信区间，1.12-1.59；P=0.001）。在女性中，RHF与死亡率增加无关。
我们证明RHF是男性而非女性死亡率的一个重要危险因素。根据性别这些不同关联的机制和临床意义需要进一步阐明。
